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Posted 4/10/2019 6:43 PM (GMT 0)
My previous post from last year is located here to provide you the background.
https://www.healingwell.com/community/default.aspx?f=35&m=3983542

But in Summary, my first biopsy was done in Jan16 and only had one core with 3+3=6 Gleason Score. The second biopsy was done in Feb18, with four (4) cores having a Gleason Score of 3+3=6 and one (1) core had a high-grade PIN.

Following are the latest compilation of PSA numbers. The last three results are perhaps indicating that cancer is growing steadily.
Dec14 = 4.5
Dec15 = 5.7
PSA numbers after starting Finastride
Apr16 = 2.7
Aug16 = 1.7
Dec16 = 2.1
Mar17 = 1.5
Dec17 = 1.8
Aug18=2.4
Dec18=3.0
Apr19=3.6

My Uro appointment is this coming Friday 4/12. What questions should I ask my Uro? I am thinking of doing another biopsy in the near future to decide if I need to continue doing the AS. Is 3T mpMRI be able to tell anything different from a standard 12 core biopsy? or should I ask for 12 core plus biopsy?

As always, Thank you for opinions and suggestions.

Ray

Fixed your link -- PeterDisAbelard

Post Edited By Moderator (PeterDisAbelard.) : 4/10/2019 1:21:00 PM (GMT-6)

Posted 4/10/2019 7:07 PM (GMT 0)
mpMRI seems perfect for someone in your situation!

You already know that you have been diagnosed with a small amount of inconsequential PC. What the mpMRI does is to "overlook" the inconsequential stuff and look for the likelihood of consequential stuff. That's what you want to know...right? Bring this up with your urologist. The mpMRI results can then be used as an input for your next biopsy...depending on the mpMRI results, that biopsy might be next month, next year, or possibly in 2 years.

PSA in an untreated man is not a good measure of prostate cancer activity...keep that in mind.
Posted 4/10/2019 7:27 PM (GMT 0)
I more or less agree with BlackJack. With more positive cores and a faster-growing-than-expected PSA it's probably time to be a bit more active in your active surveillance but there is no need to go rushing off in all directions. You know from the biopsies that you've got something going on and it's probably time for some imaging to tell you how much is going on and where. Chances are good you can continue safely on AS but there are never any guarantees.
Posted 4/10/2019 7:36 PM (GMT 0)
I agree with both of the above posters. Plus, make sure you get a second opinion on the slides from Dr. Epstein at JHU.

Jim
Posted 4/11/2019 8:12 PM (GMT 0)
Thank you for valuable input. Let's see what the URO say tomorrow.
Posted 4/24/2019 2:31 PM (GMT 0)
Sorry for the late update. I did make my 4/12 Friday appointment with URO. It seems like he is not a fan of 3T mpMRI, he said that it is very hard to have good findings from MRI. URO said he has done biopsies based on target locations from MRI and they all have come negative, so he does not have much faith in them. I asked him if these were 3T MRI's and he said yes and I am confused as my research on 3T scanners location shows that they not widely available in Texas, actually only two locations, one in Dallas and other in Galveston. He also indicated my insurance most likely will not pay for the MRI and in his opinion, it will not be beneficial. Is it true as research indicated that 3T scanners are not widely available?

As far as sending the biopsy slides to Dr. Epstein @ JHU, he feels I should rather consult doctors at MD Anderson in Houston as they see a lot more cancer patients than anyone else.

His take on the PSA numbers that are on the rise is that it is probably due to Anastrozole. He had prescribed Anastrozole (1mg) last year during the August visit, to counter one of the side-effects from Finasteride which was tenderness in the breast area. After the tenderness was gone, I was taking 3 days a week. He has now asked me to get-off the Anastrozole and do another PSA test in 3 months. Is anyone else taking or took Anastrozole that affected the PSA? It will be a great relief if my PSA numbers actually go down since I am no longer taking Anastrozole.

Any other thoughts or ideas, for the next 3 months? As always, thank you so much for your help and support.

Ray
Posted 4/24/2019 3:01 PM (GMT 0)
I disagree about his take on the MRI. Is he an older doctor?
MD Anderson is close and they are experts in cancer research.
BUT Epstein is considered the expert on PCa.
He might be right about the reason for PSA rise.
The doubling speed is about 18 months, although the last 8 months it has picked up speed.
My opinion, 3 months isn't very long, so wait for another PSA test.
If it's still rising, get a MRI guided biopsy from a different doctor.

That's my two cents.
Posted 4/24/2019 4:35 PM (GMT 0)
MD Anderson of course is great. But the cost of having the slides reviewed by Epstein is very worth it. Remember-you decide these things not your URO. The more knowledge you have the better.
Posted 4/24/2019 4:51 PM (GMT 0)
Ray,
I pretty much echo what Gobucks says. You are in charge, but a “compromise” might be to have the slides sent to Anderson, as well as Epstein, as you wait until your next PSA. That way you have more information and avoid possibly making your Uro feel slighted. I think it’s worth the extra expense because you’re on AS. Right now as much information as possible about the state of your prostate is crucial.
Posted 4/24/2019 10:17 PM (GMT 0)
Ray - I did a quick search and found more 3TMri in Texas. They are not everywhere but usually in most Metro areas such a Austin, DFW, Houston, etc.

My doctor said that he has not had problems with insurance coverage in last few years around MSP but has heard that some do. It is becoming pretty standard practice from what I can tell. Of course, an urologist that actually does them might know better.
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